Williams Michelle C, van Beek Edwin J R, Hill Adam T, Murchison John T
BHF Centre for Cardiovascular Science.
Edinburgh Imaging facility QMRI.
J Thorac Imaging. 2021 May 1;36(3):166-173. doi: 10.1097/RTI.0000000000000553.
Coronary artery calcification (CAC) on thoracic computed tomography (CT) can identify patients at risk of coronary artery disease (CAD) mortality. However, the overlap between bronchiectasis and CAC severity for predicting subsequent outcomes is unknown.
CT images from 362 patients (mean age 66±14 y, 38% male) with known bronchiectasis were assessed. Bronchiectasis severity was assessed using the Bronchiectasis Severity Index (0 to 4, mild; 5 to 8, moderate; and ≥9, severe). CAC was assessed with a visual ordinal score (0, none; 1, mild; 2, moderate; 3, severe) in each of the left main stem, left anterior descending, left circumflex, and right coronary arteries. Vessel CAC scores were summed and categorized as none (0), mild (1 to 3), moderate (4 to 8), and severe (9 to 12).
Patients with severe bronchiectasis were older (P<0.001), but were not more likely to have a history of CAD, hypertension, or smoking. CAC was present in 196 (54%). Over a mean of 6±2 years, 59 (16%) patients died. Patients with moderate or severe CAC were 5 times more likely to die than patients without CAC (hazard ratio: 5.49, 95% confidence interval: 2.82-10.70, P<0.001). Patients with severe bronchiectasis were 10 times more likely to die than patients with mild bronchiectasis (hazard ratio: 10.11, 95% confidence interval: 4.22-24.27, P<0.001). CAC and bronchiectasis severity were independent predictors of mortality, but age, sex, smoking, and history of CAD or cerebrovascular disease were not.
CAC is common in patients with bronchiectasis, and both CAC and bronchiectasis severity are independent predictors of mortality.
胸部计算机断层扫描（CT）上的冠状动脉钙化（CAC）可识别有冠状动脉疾病（CAD）死亡风险的患者。然而，支气管扩张与CAC严重程度之间对于预测后续结果的重叠情况尚不清楚。
对362例已知患有支气管扩张的患者（平均年龄66±14岁，38%为男性）的CT图像进行评估。使用支气管扩张严重程度指数评估支气管扩张严重程度（0至4为轻度；5至8为中度；≥9为重度）。对左主干、左前降支、左旋支和右冠状动脉分别进行视觉序数评分评估CAC（0为无；1为轻度；2为中度；3为重度）。将血管CAC评分相加并分类为无（0）、轻度（1至3）、中度（4至8）和重度（9至12）。
重度支气管扩张患者年龄更大（P<0.001），但患CAD、高血压或吸烟史的可能性并不更高。196例（54%）患者存在CAC。平均6±2年期间，59例（16%）患者死亡。有中度或重度CAC的患者死亡可能性是无CAC患者的5倍（风险比：5.49，95%置信区间：2.82 - 10.70，P<0.001）。重度支气管扩张患者死亡可能性是轻度支气管扩张患者的10倍（风险比：10.11，95%置信区间：4.22 - 24.27，P<0.001）。CAC和支气管扩张严重程度是死亡的独立预测因素，但年龄、性别、吸烟以及CAD或脑血管疾病史不是。
CAC在支气管扩张患者中很常见，且CAC和支气管扩张严重程度均为死亡的独立预测因素。
